UPSC-CMS 2020 Practice Questions

Q: Which one of the following is NOT a support of uterus, preventing its descent?

Inguinal ligament. ***Inguinal ligament*** - The **inguinal ligament** is a fibrous band extending from the **anterior superior iliac spine** to the **pubic tubercle**, forming the inferior border of the anterior abdominal wall [2]. - It plays no direct role in supporting the uterus; its primary function is to serve as an attachment site for muscles and define the **inguinal canal** [2]. *Endopelvic fascia* - The **endopelvic fascia** is a connective tissue layer that surrounds pelvic organs and contributes significantly to their support [1]. - It forms condensations such as the **uterosacral** and **cardinal (Mackenrodt's) ligaments**, which directly stabilize the uterus [1]. *Mackenrodt's ligament* - Also known as the **cardinal ligament** or **transverse cervical ligament**, it extends from the cervix and lateral vaginal fornix to the lateral pelvic walls [1]. - This ligament is a primary support of the uterus, preventing its descent and maintaining its position [1]. *Pubocervical ligament* - The **pubocervical ligament** extends from the anterior aspect of the cervix to the posterior surface of the pubic symphysis. - It is a condensation of the **endopelvic fascia** and provides anterior support to the uterus and bladder [1].

Q: Implantation of a fertilised ovum occurs on which day following fertilisation?

Day 6. ***Day 6*** * Fertilization occurs in the **ampulla** of the fallopian tube, and the zygote undergoes cleavage as it travels towards the uterus. * By day 5-6, the embryo develops into a **blastocyst** with an outer trophoblast layer and inner cell mass. * **Implantation begins on day 6-7** post-fertilization when the blastocyst attaches to the endometrium, making day 6 the correct answer for when implantation occurs. * The process continues and is complete by day 10-12, but the initial attachment (implantation) starts on day 6. *Incorrect: Day 14* * Day 14 marks the time of **ovulation** in a typical 28-day menstrual cycle, not implantation. * By day 14 post-fertilization, the embryo would have been implanted for approximately one week. *Incorrect: Day 20* * Implantation occurs much earlier, around day 6-12 post-fertilization. * By day 20 post-fertilization, the implanted embryo would be well into **gastrulation and organogenesis**. *Incorrect: Day 10* * While the implantation process may continue until day 10-12, it **begins on day 6**, not day 10. * Day 10 represents a later stage when implantation is nearly complete, but the question asks when implantation occurs (i.e., begins).

Q: The net effect of antenatal care has been the following EXCEPT:

Reduction in the incidence of institutional delivery. ***Reduction in the incidence of institutional delivery*** - Antenatal care aims to increase awareness of safe delivery practices and encourage women to deliver in health facilities, thereby **increasing institutional deliveries**, not reducing them. - Improved access to and understanding of obstetric care through ANC promotes safer childbirth environments. *Reduction in maternal morbidity* - Antenatal care plays a crucial role in the early detection and management of **pregnancy-related complications** such as pre-eclampsia, gestational diabetes, and infections. - This proactive management minimizes the severity and impact of these conditions on maternal health. *Reduction in perinatal mortality* - Regular antenatal visits allow for monitoring of fetal growth and well-being, identification of **fetal distress**, and intervention for conditions like intrauterine growth restriction. - Early detection and management of issues affecting the fetus significantly improve perinatal outcomes and reduce **stillbirths** and **neonatal deaths**. *Reduction in maternal mortality* - ANC provides essential health education, nutritional advice, and timely vaccinations, which are vital for a healthy pregnancy. - It also facilitates preparedness for childbirth and potential complications, thereby **reducing the risk of maternal death** from preventable causes.

Q: From medicolegal point of view which one of the following is NOT a sign of previous child birth?

Conical cervix with round external os. ***Conical cervix with round external os*** - A **conical cervix with a round external os** is characteristic of a **nulliparous woman** (never given birth). - After childbirth, the cervix typically becomes **transversely slit-like** due to the dilation during labor. *Introitus is gaping and there is presence of carunculae myrtiformis* - A **gaping introitus** is a common finding after childbirth due to the stretching and relaxation of the **vaginal outlet**. - **Carunculae myrtiformes** are remnants of the hymen that are usually fragmented during vaginal delivery. *Abdomen is lax and loose with striae and linea nigra* - **Lax and loose abdominal skin**, along with the presence of **striae gravidarum** (stretch marks) and a prominent **linea nigra** (hyperpigmented line), are classic signs of a previous pregnancy and childbirth. - These changes result from the significant stretching of the abdominal wall during uterine enlargement. *Perineum is lax and there is evidence of scarring* - A **lax perineum** indicates loss of tone in the pelvic floor muscles, which commonly occurs after vaginal delivery. - **Perineal scarring** can be a result of episiotomy or perineal tears sustained during childbirth.

Q: As per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?

COVID-19 virus is not teratogenic. ***COVID-19 virus is not teratogenic*** - Current evidence, including ICMR guidelines, indicates that the COVID-19 virus itself does not cause **congenital malformations** or developmental abnormalities in the fetus, distinguishing it from truly **teratogenic agents**. - While maternal infection can have adverse outcomes, these are generally not due to direct fetal malformation from the virus. *COVID-19 virus infection is an indication of MTP* - **MTP (Medical Termination of Pregnancy)** is not indicated solely based on maternal COVID-19 infection, as the virus is not considered teratogenic and typically does not cause severe direct fetal harm requiring termination. - Ethical and medical guidelines do not support routine termination for uncomplicated maternal COVID-19. *There is increased risk of fetal growth restriction* - While severe maternal COVID-19 can rarely be associated with *some* adverse pregnancy outcomes, a consistently and significantly increased risk of **fetal growth restriction (FGR)** is not definitively established as a direct effect of the virus itself, especially in mild to moderate cases. - Other factors, such as severe maternal illness, hypoxia, or comorbidities, are more strongly linked to FGR. *There is increased risk of early pregnancy loss* - Data from various studies has not consistently shown a significant or direct increase in the risk of **early pregnancy loss** (miscarriage) specifically due to COVID-19 infection in early pregnancy. - While any maternal infection can theoretically increase risk, COVID-19 is not classified as a primary cause of increased early pregnancy loss based on current evidence.

Q: As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?

Pregnant women with heart disease are at higher risk. ***Pregnant women with heart disease are at higher risk*** - Pre-existing **heart disease** is a significant risk factor for severe COVID-19 outcomes in pregnant women due to the increased physiological cardiac demands of both pregnancy and infection. - According to ICMR guidelines and global data, comorbidities like **cardiovascular disease** place pregnant individuals in a higher-risk category for severe illness. *COVID-19 pneumonia in pregnancy is more severe with poor recovery* - While pregnant women *can* develop severe COVID-19 pneumonia, the general consensus, including ICMR guidelines, states that most pregnant women experience **mild to moderate illness** and have a **good recovery**. - Pooled data indicates that the majority of pregnant women with COVID-19 will not develop severe pneumonia or experience poorer recovery *solely* due to pregnancy. *COVID-19 virus is secreted in breast milk* - Current evidence suggests that the **COVID-19 virus is generally not detectable** in breast milk. - ICMR and other major health organizations recommend that **mothers with COVID-19 continue breastfeeding**, as the benefits outweigh potential risks, and antibodies may be transferred. *Vaginal secretions always test positive for COVID-19 in pregnancy* - The primary transmission route for COVID-19 is through **respiratory droplets**, not vaginal secretions. - While some studies have detected viral RNA in vaginal secretions in a small percentage of cases, it is **not always positive** and is not considered a primary source of transmission.

Q: Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?

Delivery by ventouse. ***Delivery by ventouse*** - **Vacuum extraction (ventouse)** requires the fetal head to be engaged and the leading part to be no higher than 1/5th above the symphysis pubis, and it does not allow for rotation once applied. - In a **deep transverse arrest**, the fetal head is unrotated, and direct application of a ventouse without prior rotation is unsafe and ineffective, as it would apply traction in an improper direction, risking scalp injury without resolving the arrest. *Caesarean section* - **Caesarean section** is a viable and often necessary option for deep transverse arrest, especially when other rotational or instrumental delivery methods are contraindicated or unsuccessful. - It ensures safe delivery for both mother and fetus in cases of **cephalopelvic disproportion** or failed operative vaginal delivery. *Manual rotation and application of forceps* - **Manual rotation** involves an obstetrician manually turning the fetal head from the transverse to the occipito-anterior or posterior position. - After successful manual rotation, **forceps** can then be applied to facilitate vaginal delivery, provided there are no other contraindications. *Delivery by application of forceps to the unrotated head* - **Kielland's forceps** are specifically designed for rotation and delivery in cases of **deep transverse arrest** and can be applied to an unrotated head to achieve rotation without prior manual intervention. - While other types of forceps typically require the head to be in an occipito-anterior position, Kielland's forceps allow for the necessary rotation before traction is applied, making it a suitable method for managing deep transverse arrest.

Q: Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:

Breech with extended legs. ***Breech with extended legs*** - An extended leg presentation (frank breech) makes successful external cephalic version **less likely** because the **fetal legs splint the fetus**, creating a rigid, elongated configuration that resists rotation. - The extended posture restricts fetal mobility necessary for successful manipulation. - Frank breech is the **least favorable type** for ECV success. *Non engaged breech* - A **non-engaged breech** presentation indicates the fetal buttocks or feet are not yet fixed in the maternal pelvis, allowing **greater mobility** and making successful external cephalic version **more likely**. - Lack of engagement means there is ample space for the fetus to turn. *Adequate amniotic fluid* - **Adequate amniotic fluid** provides essential space and cushioning for the fetus to move, which is crucial for a successful external cephalic version. - It reduces friction and allows for easier manipulation of the fetus during the procedure. - Oligohydramnios is a relative contraindication to ECV. *Complete breech with sacroanterior position* - A **complete breech** (with flexed hips and knees) is generally **more favorable** for external cephalic version compared to frank breech, as the flexed posture creates a more compact, mobile configuration. - The fetal position (sacroanterior, sacrotransverse, or sacroposterior) has less impact on ECV success than the **type of breech presentation** (complete vs. frank). - Complete breech allows easier manipulation than the rigid frank breech configuration.

Q: During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:

During division and ligation of the round ligaments. ***During division and ligation of the round ligaments*** - The round ligaments are located **far from the ureters**, passing through the **inguinal canal** anteriorly. - They are **anterior and lateral** to the broad ligament and do not cross the ureteral path. - **Ureteral injury is highly unlikely** during their division and ligation, making this the correct answer to the EXCEPT question. *During division and ligation of mackenrodt's and uterosacral ligaments* - The **ureter passes about 1-2 cm lateral to the cervix** at the level of the internal os, in close proximity to the **cardinal (Mackenrodt's) and uterosacral ligaments**. - These ligaments provide significant support to the uterus and are one of the **most common sites of ureteral injury** during hysterectomy. - The ureter is particularly vulnerable during clamping and ligating these structures. *At the vaginal angles while incising the vagina to remove the cervix with the uterus* - The **ureters are at the level of the vaginal fornices** as they course toward the bladder base. - This is a well-recognized **high-risk area** for ureteral injury during vaginal cuff clamping and incision. - The ureter can be inadvertently caught in the clamps applied to control bleeding from the vaginal angles. *During division and ligation of infundibulopelvic ligaments* - The **infundibulopelvic ligament** (IP ligament or suspensory ligament of the ovary) contains the **ovarian vessels**. - The ureter runs along the **pelvic sidewall immediately medial and posterior** to the IP ligament. - This is another **high-risk area** for ureteral injury, especially if the ligament is not elevated adequately away from the pelvic sidewall during clamping.

Q: Which one of the following is NOT a component of active phase in the partograph?

Phase of expulsion. ***Phase of expulsion*** - The **phase of expulsion** (or the second stage of labor) begins after the cervix is fully dilated and ends with the birth of the baby. - While it immediately follows the active phase, it is not considered a component of the **active phase** itself, which primarily focuses on cervical dilation progress. *Acceleration phase* - The **acceleration phase** is an early part of the active phase of labor where the rate of cervical dilation begins to increase. - It marks the transition from the latent phase to the more rapid dilation characteristic of active labor. *Phase of deceleration* - The **phase of deceleration** occurs towards the end of the active phase, just before full cervical dilation, where the rate of dilation slows down. - This phase is typically associated with the advancing fetal head encountering the pelvic floor. *Phase of maximum slope* - The **phase of maximum slope** (or maximum ascent) is the steepest part of the active phase, where cervical dilation occurs at its fastest rate. - This is the most efficient period of cervical change during labor.

Question 1

Which one of the following is NOT a support of uterus, preventing its descent?

Accepted Answer

Inguinal ligament

Answer

Endopelvic fascia

Answer

Mackenrodt's ligament

Answer

Pubocervical ligament

Question 2

Implantation of a fertilised ovum occurs on which day following fertilisation?

Accepted Answer

Day 6

Answer

Day 14

Answer

Day 20

Answer

Day 10

Question 3

The net effect of antenatal care has been the following EXCEPT:

Accepted Answer

Reduction in the incidence of institutional delivery

Answer

Reduction in maternal morbidity

Answer

Reduction in perinatal mortality

Answer

Reduction in maternal mortality

Question 4

From medicolegal point of view which one of the following is NOT a sign of previous child birth?

Accepted Answer

Conical cervix with round external os

Answer

Introitus is gaping and there is presence of carunculae myrtiformis

Answer

Perineum is lax and there is evidence of scarring

Answer

Abdomen is lax and loose with striae and linea nigra

Question 5

As per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?

Accepted Answer

COVID-19 virus is not teratogenic

Answer

COVID-19 virus infection is an indication of MTP

Answer

There is increased risk of fetal growth restriction

Answer

There is increased risk of early pregnancy loss

Question 6

As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?

Accepted Answer

Pregnant women with heart disease are at higher risk

Answer

COVID-19 pneumonia in pregnancy is more severe with poor recovery

Answer

COVID-19 virus is secreted in breast milk

Answer

Vaginal secretions always test positive for COVID-19 in pregnancy

Question 7

Which one of the following is NOT a method of management of Deep Transverse Arrest with the living fetus?

Accepted Answer

Delivery by ventouse

Answer

Caesarean section

Answer

Manual rotation and application of forceps

Answer

Delivery by application of forceps to the unrotated head

Question 8

Successful external cephalic version of breech presentation is likely in case all of the following EXCEPT:

Accepted Answer

Breech with extended legs

Answer

Non engaged breech

Answer

Adequate amniotic fluid

Answer

Complete breech with sacroanterior position

Question 9

During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:

Accepted Answer

During division and ligation of the round ligaments

Answer

During division and ligation of infundibulopelvic ligaments

Answer

During division and ligation of mackenrodt's and uterosacral ligaments

Answer

At the vaginal angles while incising the vagina to remove the cervix with the uterus

Question 10

Which one of the following is NOT a component of active phase in the partograph?

Accepted Answer

Phase of expulsion

Answer

Acceleration phase

Answer

Phase of deceleration

Answer

Phase of maximum slope

UPSC-CMS 2020

Anatomy

Community Medicine

Forensic Medicine

Obstetrics and Gynecology